24 Elisad annual meeting Arezzo October 2012

Transcription

1 24 Elisad annual meeting Arezzo October 2012 From addiction to consumption: The evolution of the phenomenon and the interventions of services

2 The big change:back to the late 90 and the zero decade On the side of the demand: The new drug scene in southern Europe and in Italy: - -The roof of intravenous heroin users - Aids and 1996 anti retroviral survival therapy - The fall of the heroin user in youth s imagery - The substituition of opiates with performance drugs - The normalization of consumption On the side of the offer: The choice of narco-trafficking: - Cocaine: from elite users to mass consumption

3 That means : Heroin intravenous users have not disappeared (i.e. in Emilia-Romagna 63% of the clients treated in drug health services are I.D.U.) Cocaine problematic users have progressively increased the percentage of people in treatment ( about 15%) Polydrug consumption and abuse have become the new treatment area

4 What is the real extension of illicit drug use? Controversial data: the hard decrease of the 25% of the drug consumers in 2009 in Italy, (from 32% to 22% for cannabis users at least once in their life ),as suggested by DNPA (Antidrug National Policy Department) and confirmed in 2011, is not a reliable datum. The significant decrease seems mainly due to the change in the survey method. Generally, the trend of consumption, since 2008 (the top period of high consumption),has been slowly decreased ( heroin and cocaine) has been slowly increased (ketamina), has not significantly varied (LSD, other drugs).

5 Prevalence of cannabis consumption in general population in Italy Age range una tantum year month % 14,3% 6,9% ,3% 9,9% ,3% 11% Source:OEDT,2011

6 Prevalence of cocaine consumption in general polulation Age-range una tantum year month % 2,1% 0,7% ,1% Source: EMCDDA,2011

7 Prevalence of intravenous opium consumers in general population: 4,9 persons : 1000 inhabitants Primary drugs of choice of clients in treatment are: - heroin 69,3% - cocaine 15,3% -cannabis 9,2%

8 First evidence: the big three -Alcohol, tabacco and cannabis are the psychoactive substances which are most used among population, mainly years. -The percentage of their consumption vary from 11% (last month) for cannabis to 60% for alcohol - Overlapping: cannabis alcohol (+90%),cannabistabacco (+60%) -The fidelity to the big three is estimated about 80% of the consumers

9 Second evidence: licit drugs Among non illicit drug consumers in the last year: - 68% used alcohol - 20% smoked tobacco daily

10 Four different sets Alcohol tobacco consumers Alcohol, tobacco and cannabis consumers Poly-illicit-drug (non IDU)consumers (+ alcohol,tobacco and cannabis) IDUs

11 Compatible consumptions Qualitative research in cocaine use: Cohen,Decorte,Zuffa on self-controlled and out of control consumption - Different kinds of self- controlled consumption are reported - Every cocaine consumer develops his own way to self-regulation learning by trials and errors - Out of control cocaine consumers and selfcontrolled are not separated populations, because the experience of loss of control is common to both of them

12 Rootlessness of young users New phenomenon of continuative travellers Squatting and survival strategies Drug consumption: - Ketamine (+ 4,1%), - LSD -.

13 The change in the methods of consumption Sniffing Smoking Injecting

14 Risks connected with consumption Acute Chronic Behavioural: Three V -velocity (driving ) - violence ( fight ) - virus ( TSD )

15 Outreach interventions Night-life : loisir, rave-parties, Hooligans and different kinds of risk-groups. Drug scene But: - temporary projects (based on occasional funding) and not services - differently located in North and South of Italy - cuts in public expenditure

16 2011 Treatment Addicted people in treatment : ( in 2010) New addicted people asking for treatment: (-2,7% compared to 2010) People estimated eligible to treatment (hidden phenomenon): for opioids for cocaine for cannabis

17 Different kinds of treatment Substitution treatment: 64,4% -methadone 75,1% -buprenorphine 13,6% -others 11,0% Psycho-social treatment: 33,4% -social interventions 58,3% -psychological support 30,5% -psychotherapy 11,2% ( T.C. : 5-7%)

18 Harm reduction has been stopped Law does not allow: - drug injecting consumption rooms - heroin medical prescription - pill-testing Significant experiences of connection between health harm reduction and social harm reduction

19 The graying of intravenous drug users Italian record: number of older users in treatment (over 39 years) Average of new clients : 31,6 years Number of years before asking for treatment: 8,9 years ( range: 4,4-11,0) -opioids 7,7 years -cocaine 10,8 -cannabis 9,2

20 HIV,HCV,HBV prevalence National average of non-tested treated users: 69,5% Increasing percentage of HIV infection among new service-clients since 2009 Prevalence of infections among treated users : -HCV positive: 62,4% -HBV : 36,5% -Hiv : 8,8% But: Prevalence of infections among 2011 new clients: -HCV positive: 22,8% -HBV : 14,5% -HIV : 6,0%

21 Drug use related death Since 1999 decreasing trend of drug use related deaths: 1999 : 1002 deaths 2011 : 362 Average age of death: 37 years

22 Law and imprisonment Fini-Giovanardi law 2006 hardened conditions for consumers: - no difference between cannabis and hard drugs - diminished threshold between personal consumption and dealing - Increased penal punishments for small and big dealing

23 Prison conditions Overcrowding: prisoners vs officially provided Loss of rights (health, study,work, privacy,safety ) Diagnosed drug addicts in prison: 9845 people ( 19% of prisoners) Drug consumers in prison: people ( 27,7% of prisoners). Drug addicted prisoners who benefit from detention alternatives : 895 people. Increasing number of underaged entering prison

24 Drug addicted migrants Increasing number in jail since 15 years De facto,different laws and different application of the same law Stricter measures for the sans papiers Difficulties in treatment and mainly in posttreatment rehabilitation

25 More cuts in services Slow decreasing of services and their staff Some T.C were dismissed Less investment in rehab: -2,5% from 11,9 million (2010) to 9,4 (2011) Notwithstanding: -estimated social cost of addiction of 31,2 billions 2011= 2,0% PIL